Classification and Assessment of Abnormal Behavior How are abnormal behavior patterns ...

19 Pages·2008·4.06 MB·English

by  Sheila Grant

B
E
H Chapter 3
A
V
I
O Classification and
R
Assessment of
D Abnormal Behavior
I
S
O
R
D Sheila K. Grant, Ph.D.
E Professor
R
S
B How are abnormal behavior
E
H patterns classified?
A
V •  Diagnostic Statistical Manual of Mental
I Disorders (DSM-IVR)
O
R •  International Statistical Classification of
Diseases and Related Health Problems
D
I (the ICD-10)
S
O •  DSM-IV is compatible with the ICD, so that
R DSM diagnoses could be coded in the ICD
D system as well.
E
R
S
B The DSM and Models of
E
H Abnormal Behavior
A
V •  DSM system (like the medical model) treats
I abnormal behaviors as signs or symptoms of
O underlying disorders or pathologies.
R
•  However, the DSM does not assume that
D
I abnormal behaviors necessarily reflect biological
S causes or defects.
O
R •  Authors of DSM recognize that their use of the
D
term mental disorder is problematic.
E
R
S
1
B
Features of the DSM
E
H
A •  DSM is descriptive, not explanatory.
V
I
O •  Describes the diagnostic features—or, in
R medical terms, symptoms—of abnormal
behaviors.
D
I
S •  Does not attempt to:
O
• explain origins of abnormal behaviors or
R
D • adopt any particular theoretical framework.
E
R
S
B
Features of the DSM
E
H
A •  DSM recommends clinicians assess mental state
V according to five factors, or axes.
I •  Together the five axes provide a broad range of
O information about the individual’s functioning, not just a
R diagnosis.
D •  The system contains the following axes:
I 1. Axis I: Clinical Disorders and Other Conditions
S That May Be a Focus of Clinical Attention.
O 2. Axis II: Personality Disorders and Mental Retardation.
R 3. Axis III: General Medical Conditions.
D 4. Axis IV: Psychosocial and Environmental Problems.
E 5. Axis V: Global Assessment of Functioning.
R
S
B
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
2
B Features of the DSM
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
B Features of the DSM
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
B Features of the DSM
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
3
B Features of the DSM
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
B
Culture-Bound Syndromes
E
H
A •  Culture-bound syndromes - Patterns of
V abnormal behavior found within only one or a few
I cultures.
O
R •  Culture-bound syndromes may reflect
exaggerated forms of common folk superstitions
D
and belief patterns within a particular culture.
I
S
O •  Culture-bound syndromes in United States
R include anorexia nervosa and dissociative
D identity disorder (formerly called multiple
E personality disorder).
R
S
B
Culture-Bound Syndromes
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
4
B
Evaluating the DSM System
E
H
A •  To be useful, a diagnostic system such as the
V DSM must demonstrate reliability and
I validity.
O
R
•  Reliability - In psychological assessment,
D consistency of measure or diagnostic
I instrument or system.
S
O •  Validity - Degree to which test or diagnostic
R
system measures the traits or constructs it
D
E purports to measure.
R
S
B Advantages and Disadvantages
E
H of the DSM System
A
V •  Major advantage: designation of specific
I
diagnostic criteria.
O
R
•  Critics challenge utility of particular symptoms or
D features associated with particular syndromes or of
I specified diagnostic criteria.
S
O •  Another concern is that medical model focuses on
R categorizing psychological (or mental) disorders.
D
E
R
S
B
Advantages and Disadvantages
E
H of the DSM System
A
V
I •  Critics also complain that DSM system might
O stigmatize people by labeling them with
R psychiatric diagnoses.
D
•  Sanism - The negative stereotyping of people
I
S who are identified as mentally ill.
O
R • DSM system has become part of everyday
D practice of most U.S. mental health
E
professionals.
R
S
5
B
E
H
A
V
I Standards of
O
R
assessment
D
I
S
O
R
D
E
R
S
B
Reliability
E
H
A
The reliability of a method of assessment, like
V
I that of a diagnostic system, refers to its
O consistency.
R
An assessment technique has internal
D
consistency if the different parts of the test
I
S yield consistent results.
O
R An assessment method has test–retest
D reliability if it yields similar results on
E separate occasions.
R
S
B
Reliability
E
H
A •  Assessment method that relies on judgments from
V observers or raters must show interrater reliability.
I
O •  Raters must show a high level of agreement in their
R ratings.
D •  For example, two teachers may be asked to use a
I behavioral rating scale to evaluate a child’s
S aggressiveness, hyperactivity, and sociability.
O
R •  The scale would have good interrater reliability if
D both teachers rated the same children in similar ways.
E
R
S
6
B
Validity
E
H
A •  Assessment techniques must also be valid;
V i.e., instruments used in assessment must measure
I what they intend to measure.
O
R •  Content validity - Degree to which content of a
test or measure represents the content domain of
D
construct it purports to measure.
I
S
O •  Criterion validity - Degree to which test
R correlates with an independent, external criterion
D or standard.
E
R
S
B
Validity
E
H
A • Construct validity - Degree to which a test
V measures the hypothetical construct that it
I purports to measure.
O
R • Construct validity of test of anxiety requires the
results of test to predict other behaviors that would
D
be expected, given your theoretical model of
I
anxiety.
S
O
R • A test may be reliable (give you consistent
D responses) but still not measure what it purports
E to measure (be invalid).
R
S
B
E
H
A
V Methods of assessment
I
O
R
D
I
S
O
R
D
E
R
S
7
B
The Clinical Interview
E
H
A Although the format may vary, most
V
interviews cover these topics:
I
O
R 1.  Identifying data.
2.  Description of presenting problem(s).
D
I 3.  Psychosocial history.
S 4.  Medical/psychiatric history.
O
5.  Medical problems/medication.
R
D
E
R
S
B
Interview Formats
E
H
A •  Unstructured interview - Clinician adopts his
V or her own style of questioning rather than
I following any standard format.
O
R •  Semistructured interview - Clinician follows
a general outline of questions designed to gather
D
essential information but is free to ask them in any
I
order and to branch off in other directions.
S
O
R •  Structured interview - Interview that follows
D a preset series of questions in a particular order.
E
R
S
B
Computerized Interviews
E
H
A •  In computerized clinical interview, people
V respond to questions about their psychological
I symptoms and related concerns that are posed to
O them on a computer screen.
R
•  Evidence shows: people tend to reveal as
D
much if not more personal information to a
I
computer than they do to a human interviewer.
S
O
R •  Computer interview may actually be more
D helpful in identifying problems that clients are
E embarrassed or unwilling to report to a live
R interviewer
S
8
B
Psychological Tests
E
H
A •  A psychological test is a structured method of
V assessment used to evaluate reasonably stable traits.
I
O •  Tests are usually standardized on large numbers of
R subjects and provide norms that compare clients’ scores
with the average.
D
I •  By comparing test results from samples of people who
S are free of psychological disorders with those of people
O who have diagnosable psychological disorders, we may
R gain some insights into the types of response patterns
D that are indicative of abnormal behavior.
E
R
S
B
Intelligence Tests
E
H
A
V
•  Assessment of abnormal behavior often
I
O includes an evaluation of intelligence.
R
•  Attempts to define intelligence continue to
D stir debate in the field.
I
S
•  First formal intelligence test was developed
O
by a Frenchman, Alfred Binet (1857–1911).
R
D
E
R
S
B
Intelligence Tests
E
H
A •  Intelligence, as given by a person’s
V
scores on intelligence tests, is usually
I
O expressed in the form of an intelligence
R quotient, or IQ.
D
I •  Wechsler’s intelligence scales are today
S the most widely used intelligence tests.
O
R
D •  Most IQ scores cluster around the
E mean.
R
S
9
B
Intelligence Tests
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
B
E
H
A
V
I
O
R
D
I
S
O
R
D
E
R
S
B
Objective Tests
E
H
•  Objective tests - Self-report personality tests that
A
can be scored objectively and are based on a research
V
foundation.
I
O
•  People are asked to respond to specific questions or
R
statements about their feelings, thoughts, concerns,
attitudes, interests, beliefs, and the like.
D
I
•  Subjects might be instructed:
S
• to check adjectives that apply to them,
O
• to mark statements as true or false,
R
• to select preferred activities from lists, or
D
• to indicate whether items apply to them
E
“always,” “sometimes,” or “never.”
R
S
10